Mental Health and Student Athletes

Shortly before the start of the 2018-2019 season, I sat down with the University of Texas men’s basketball head coach, Shaka Smart, in his office at Darrell K. Royal Texas Memorial Stadium. Coach Smart enters his fifth season as head coach and is coming off a 2019 National Invitation Tournament championship.

At that time, I had just created “This is Mental Health,” a podcast featuring unlikely advocates for mental wellness. Through my conversation with Coach Smart, I wanted to better understand the intersection of elite sports and mental health, as well as the specific challenges student-athletes face.

As a psychiatrist, I am accustomed to having conversations about mental health. Patients come to my office every day because they are struggling with depression or anxiety, or even finding their purpose. There’s always a bit of vulnerability in these initial sessions, and often people don’t know where to start. Visiting a mental health professional takes courage, because we still live in a society that stigmatizes mental illness as a sign of weakness.

When I met Coach Smart, he was standing behind his desk studying game film on a large monitor, analyzing plays with surgical precision, chin in hand. Sports memorabilia adorned the room: placards, trophies and autographed basketballs. There were stacks of books everywhere.

He was thoughtful in his response and quick to point out that “[mental health discussions are] an important topic all the time,” Smart says, “but particularly in this day and age when athletes are dealing with more noise than they’ve ever dealt with in the past.The expectations, the pressure, the anxiety that can build can impact everything.”

Transitioning to college can be difficult for many students. The stressors of leaving home and living independently are faced by all college freshmen. Evidence shows that depression and anxiety are common among college students. Add to that the risk of over-training, susceptibility to physical injuries and the media scrutiny that accompanies high-profile athletes, we can imagine how studies also support that student-athletes are not immune from mental health concerns. Several large surveys indicate that between 20 and 30 percent of student-athletes struggle with depressive symptoms.

Despite mental health support systems in place within many college athletic departments, seeking help is often difficult for student-athletes. Retaliation from coaches is cited as one of the major reasons why student-athletes don’t approach coaching staff when they are struggling. Student-athletes fear not only being perceived as frail, but also fear less playing time — or even being benched after admitting to mental health concerns.

“I get it,” Smart says. “You have to remember the way we have defined masculinity in this country for years — and particularly in sports — is ‘be tough, be a man, don’t admit when you’re feeling down, don’t ask for help, don’t show emotion,’ and so, I can see why athletes feel that way.”

Smart isn’t the only NCAA coach thinking about mental health. Kendall Brooks comes from a tennis family and was a four-year letter winner at Texas Tech before transitioning directly from player to coach. She enters her seventh season as head coach of women’s tennis at St. Edward’s University.

Earlier this summer, I met Coach Brooks for coffee. She says she believes that the emotional challenges women-athletes face perhaps are different than those of men.

“I do think men are expected to be a lot tougher,” Brooks says. “Don’t get me wrong — female athletes are tough and they can persevere, but it’s the stigma all the way around of men thinking they can’t be sensitive. As a male, and especially as a male athlete…there’s no crying when you lose…I think there’s not that same thought in women’s sports, but at the same time, they’re expected to be tough and perform and work just as hard as the males.”

Acknowledging that when we discuss the relationship between mental wellness and athletics, depression and anxiety are not the only conditions to consider. Coach Brooks accurately points out that we also have to be aware of the increased risk for eating disorders among women, though men are at risk, too.

I was delighted by the ease with which Coach Brooks navigated our discussion about mental health. It’s important for student-athletes to appreciate that a growing number of coaches around the country are thinking about mental health every day and actually welcome open discussion about mental wellness.

Coach Brooks believes that coaches have to set the tone by creating an environment of trust with their student-athletes.

“If they trust me, they’ll confide in me, but I have to earn that trust,” Brooks says.

Some studies claim that depression rates are even higher in female athletes when compared to male athletes. Coach Brooks suggests that although showing emotion may be “more acceptable in women’s sports,” gender stereotypes allow displays of certain types of emotion to be misinterpreted.

“I think about Serena Williams and other athletes when they show emotion or get angry,” Brooks says.“Some will say you’re not supposed to do that — you’re a woman, so expressing emotions that way, outwardly in front of people, the same way that male athletes do, is just perceived differently.”

So how do we create a supportive environment for student-athletes?

As a psychiatrist, I believe that it starts first with open conversations. If student-athletes hear coaches publicly encouraging players to seek help when they need it, then it sends a loud message that talking about mental health is okay.

Coach Brooks agrees.

“I think there has to be more dialogue on the topic — coaches need to talk about it more,” Brooks says. “We have athletic trainers to take care of your body, but who’s taking care of your mind?”

Last year, NBA all-star forward, Kevin Love, penned an article in The Players’ Tribune admitting to his personal struggles with anxiety and panic attacks. Since then, he has continued to champion productive conversations about mental health. We need to understand the role all of us play in improving mental health and wellbeing. We don’t have to wait for tragedy to speak up in order to advocate for wellness.

Coach Smart believes that social and emotional learning should be a part of early childhood education.

“Young men are taught a certain definition of masculinity that actually goes completely against what Kevin Love was admitting to,” Smart says. “Just for kids to learn to acknowledge what they’re feeling and what they’re thinking. To separate emotions from experiences and thoughts from the essence of who they really are — that’s a powerful tool to have well before you get to college.”

The NCAA has recognized the importance of supporting student-athlete mental wellness and has developed the Coaches Assist for Empathic Response training video. The training focuses on helping coaches develop constructive methods of talking about mental health with student-athletes.

As for a message to student-athletes who are skeptical about seeking professional help, Coach Brooks adds that “you can overcome anything with the right amount of support….We talk about mental toughness, but that doesn’t mean that you have to be mentally tough all the time.”

At UT, Coach Smart offers a unique approach to keeping mental wellness front and center.

“When it relates to [student-athlete] development, we put it in a triangle: body, mind and game, and we really have to make sure that the mind part does not get ignored,” Smart says.

Physical activity, exercise and mind-body practices have been found to reduce depression and anxiety, as well as promote recovery from a number of physical and mental health concerns. However, even the most physically fit are vulnerable to mental illness, and elite athletes also need emotional support.

It’s encouraging that more players and coaches are speaking up about mental health. One conversation at a time, we can turn the page on stigma and create an environment of hope for student-athletes.